Os i1

OSCE PEDIATRICS
IMAGING part One
X-Rays/CT/MRI
www.dnbpediatrics.com

• If patient presents with fever and toxaemia,
give three differential diagnosis
• Give three modalities of management

1. Lung Abcess
2. Infected Bronchogenic cyst
3. Infected Hydatid Cyst
1. Antibiotics (anaerobic +aerobic)
2. Chest physiotherapy
3. Percutaneous CT guided aspiration
0.5 each
Total 3 markswww.dnbpediatrics.com

• What is the lesion ?
• Give two management modalities.
• What complication can occur
during management & how can it
be prevented?

Q1:
• NCC 1
Q2:
• Anticonvulsants 1
• Albendazole
• Increase in Cerebral Edema 1
• Use steroid cover
Total 3 marks

• Describe the lesion.
• What are the management modalities of
such lesions especially if they are leading
to complications ? www.dnbpediatrics.com

• Haemangioma scalp 1
• Conservative 2
• Oral steroids
• Local steroids
• PDL: pulse dyed laser
• IFN alfa interferon (in case of
haemangiomas causing pressure effects or
erosion leading to significant morbidity)

• What are two imp radiological abnormalities?
• What is the diagnosis ?
• What are the three imp investigations ?
• What are the metabolic abnormalities expected?
• What is the management ?

• Q1Distension of stomach
• No gas in the intestines
• Q2Pyloric Stenosis
• Q3USS abdomen: pyloric thickness >4mm/
pyloric length >14 mm
S electrolytes
Ba studies
• Q4Hypochloremic, hypokalemic, metabolic
alkalosis
• Q5Management of the fluid & electrolytes
Ramstedt’s pyloromyotomy 0.5 each

• What is the management ? www.dnbpediatrics.com

Pnematoceles 1
Likely organism Staphylococcus 1
Total 2 markwww.dnbpediatrics.com

• Give five radiological findings ?
• What is the management ? www.dnbpediatrics.com

• 1 Ground glass appearance of bone 2
• 2 Thinned cortex
• 3 Periosteal calcification
• 4 White line of Fraenkel (well calcified cartilage)
• 5 Wimberger’s sign (white ring)
• Q2 Scurvy 1
• Q3 1 Vit C 100-200 mg/ day 1
2 Dietary Therapy
Total 4 marks

• What was the lesion ?
• What was the procedure carried out ?
• What are the complications ?

• VSD 1
• Device implant 1
• Device displacement 2
• Emboli formation
• Haemolytic Anaemia

• Name the Investigation ?
• What are the further investigations ?

• MCU
• Posterior urethral Valves
• DTPA (diethylene tetra amine pentoic acid)
Function
• DMSA (dimercapto succinic acid) -scarring

• What is the abnormality?
• How is it suspected clinically ?
• What is the management ?

1. Bowel loops in lt hemithorax, mediastinal shift to righ 1
2. Congenital diaphragmatic hernia 1
3. Respiratory distress 1
Mediastinal shift
Bowel sounds in the thorax
Scaphoid abdomen
4. Avoid Bag &Mask vent 2
prop up and decompress stomach
Ventilate
Treat PPHN
Surgical correction
Antenatal tracheal ligation

What is the abnormality?
What is the likely
diagnosis?
Delineate management.
Mention 3 complications

• Multiple fluid levels.
gasless lower abdomen 1
• Small bowel obstruction 1
• Surgical correction 1
• Dyselectrolytemia 1
Perforation
Exaggerated hyperbilirubinemia
Dysmotility syndrome

• Describe the X –ray
• Diagnosis
• Give three recent advances in management

• Hyper inflated lung fields with areas of
atelectasis interspersed with areas of
overinflation 1
• MAS 1
• Lung lavage
surfactant instillation
HFOV
NO
liquid ventilation 2

• What is the abnormality
• Three high risk situations when this condition is
imminent
• Management

• Pneumothorax 1
• CDH
Ventilation
Post surfactant ventilation 2
• Chest tube drainage 1

• What is the abnormality
• What is it a complication of

• Pneumomediastinum 1
• Forceful ventilation 1

• Identify the abnormality
• Clinical presentation
• Treatment

• Pneumopericardium 1
• Shock with weak pulses 1
• Drainage 1

• What are the MRI findings ?
• What is the DD
• What further inv will you do on the CSF to
confirm the diagnosis ? www.dnbpediatrics.com

3 marks
Acute disseminated encephalomyelitis

Oligoclonal bands are also found in:
• Multiple sclerosis
• Devic's disease
• Systemic lupus erythematosus
• Neurosarcoidosis
• SSPE
• Subarachnoid haemorrhage
• Syphilis
• CNS Lymphoma

• What could be the etiology ?

• Multifocal cerebral & cerebellar
encephalomalacia
• Sequel of ischaemic injury in the perinatal
period.
2 markswww.dnbpediatrics.com

• What is the likely
diagnosis ?
• What is the IP?
• Which is the commonest
site?

• TB Spine 1
• 2 YRS 1
• Thoraclumbar
area of max stress
valveless venous drainage 2
4 markwww.dnbpediatrics.com

• Likely etiology
• Likely CSF picture

3 mark
Q2 TBM
Q3 Increased proteins
Increased cells likely lymphocytes
Low sugar

• What is the X ray suggestive of ?
• What is the likely organism?
• What are the complications?
• What is the drug of choice?
• What is the duration of therapy? www.dnbpediatrics.com

• Lobar Pneumonia
• Pnemococous/Staphylococcus
• Synpneumonic effusion, empyema,
• Penicillin for susceptible org and
cefotaxime / vancomycin for penicillin
resistant org
• 10-14 d
5 marks

Questions
1. What is the anatomical structure in which
coin is lodged?
2. What is the location of carina with
respect to thoracic vertebrae?
3. What are the anatomical areas of
esophageal narrowing?
4. How can this foreign body be removed?

Answers
• Esophagus
When foreign bodies lodge in the esophagus, the flat
surface of the object is seen in the AP view *
• T 4
• Anatomic areas of esophageal narrowing
– Cricoid
– Tracheal bifurcation
– Gastro-esophageal junction
• Endoscopy
*
1
1
3
1

Question
1. What is the diagnosis?
2. Fill in the blanks
In an exudative pleural fluid
a. Proteins >
b. Pleural Fluid LDH > ………….
c. Fluid to serum LDH ratio > ………..
d. Cell count ………
3. What does VATS stand for?

Answers
1. Pleural Effusion (Right)
2. Fill in the blanks
In an exudative pleural fluid
a. Proteins > 3.0 g/dL
b. Pleural Fluid LDH > 200 IU/L
c. Fluid to serum LDH ratio > 0.6
d. Cell count > 1000
3. Video Assisted Thoracoscopic Surgery
2
0.5
0.5
0.5
0.5
1

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